Application for Housing
Please complete the application below. Successful completion of this form does not reserve a room. You must also submit copies of your medical insurance card and meningitis vaccination record. Rooms are first come first serve once all components of the application process are complete.
Student Name
*
First Name
Middle Name
Last Name
If requested,I give Panola College Res Life Staff promission to share contact information with future roommates or suitmates.
Please Select
Yes
No
Student ID#
*
E-mail
*
example@example.com
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
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2016
2015
2014
2013
2012
2011
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Ethnic Origin
Please Select
American Indian/Alaskan Native
Asian Pacific
Black Non-Hispanic
Hispanic
Non Resident Alien
White Non-Hispanic
Gender
Please Select
Male
Female
N/A
Preferred Pronouns
Please Select
He/Him
She/Her
They/Them
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Mobile Number
*
Alt. Phone Number
*
Legal Name
First Name
Last Name
Preferred Name
First Name
Last Name
STUDENT ID PHOTO: Please upload a headshot of yourself without sunglasses, without a hat, and with a light background, for your potential student ID card:
*
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Which semester are you applying for?
*
Please Select
May Term
Summer I
Summer II
Fall
Spring
Do you have a concealed handgun license?
*
Please Select
Yes
No
I decline to answer
First Choice Housing:
Please Select
Apartment
Traditional
O'Neal Hall
Second Choice Housing:
Please Select
Apartment
Traditional
O'Neal Hall
Would you be interested in a single room for an additional cost of $800-$1200 (depending on location - $800 Sharp Hall, $1000 - Apartments, $1200 Oneal Hall) if availability allowed us to offer a single room? Single rooms are not guaranteed currently but you will be notified if they become available.
Please Select
Yes
No
Roommate Preference:
Suitemate Preference:
Hobbies:
Major:
Are you an official member of one of the following?
*
Please Select
Band
Baseball
Choir
Men's Basketball
Rodeo
Theater
Volleyball
Women's Basketball
NONE
Upload your meningitis shot record below:
*
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Do you have medical insurance?
*
Yes
No
Upload a copy of the front and back of your medical insurance card below:
*
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List of allergies:
*
Please download, fill out, and return the medical coverage waiver form. The form can be found on www.panola.edu on the Residence Life & Housing webpage.
Follow the link below to fill out the Panola College Medical Waiver and upload: https://www.panola.edu/sites/default/files/2021-07/medical-waiver.pdf
*
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I release this information to Panola College:
*
Please Select
Yes
No
I understand that I must submit a copy of my meningitis shot record and a copy of my medical insurance card to complete my application.
*
I understand that Panola College reserves the right to run criminal history reports on all potential residents and that my housing application may be denied based on the results of that report.
*
Please verify that you are human
*
Submit Application
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